Clinical Chemistry
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Clinical Chemistry 55: 1236-1239, 2009. First published April 24, 2009; 10.1373/clinchem.2009.127522
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(Clinical Chemistry. 2009;55:1236-1239.)
© 2009 American Association for Clinical Chemistry, Inc.

Q&A

Mass Spectrometry in the Clinical Laboratory: How Have We Done, and Where Do We Need to Be?

Thomas Annesley1

1 Department of Pathology, University of Michigan Health Sciences Center, Ann Arbor, MI.

The first 300 words of the full text of this article appear below.

Mass spectrometry has long been used in clinical laboratories. The first important applications were the use of gas chromatography–mass spectrometry (GC-MS) for drug screening and the diagnosis of organic acid metabolic disorders. More recently liquid chromatography–mass spectrometry [LC-MS; liquid chromatography–tandem mass spectrometry (LC-MS/MS1 )] has been introduced successfully into clinical laboratories, where it has become the gold standard for newborn screening. The prices for basic LC-MS/MS systems have decreased, and these systems are adequate for many clinical applications. At the higher end, LC-MS/MS systems with enhanced capabilities now permit the analysis of clinically important compounds that are present in very low concentrations in biological fluids.

Although GC-MS and LC-MS instruments provide advantages over other techniques, financial, clinical, and analytical implications must be considered when deciding which technique to choose or interpreting results that may differ from other conventional assays. To gather the observations, opinions, and predictions of individuals with varied experiences in the mass spectrometry arena, we present here a virtual roundtable with a panel of 5 experts: a clinician, a researcher, 2 clinical chemists, and a clinical business manager from an instrument manufacturer.

As a pediatric endocrinologist, have you seen an influence of mass spectrometry on your diagnosis and treatment of patients?

Joseph Majzoub2 : Absolutely yes, in both positive as well as challenging ways. Mass spectrometry provides better results with much improved specificity over immunoassays for the analytes that I monitor. As a clinician, however, I often deal with multiple laboratories with different levels of testing or different methods. Some laboratories do not do prepurification of samples before immunoassay, which results in different answers because of different effects of structural analogs. The methodologies used by laboratories have also changed over time, so it is challenging sometimes to decide if a change is in the patient or the assay.

. . . [Full Text of this Article]






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Copyright © 2009 by the American Association for Clinical Chemistry.